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Hi-Desert Water District
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Vacant Lot or Unoccupied Business FOG Application Notification
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This form has been modified since it was saved. Please review all fields before submitting.
This property is:
*
Vacant unimproved lot
Unoccupied commercial business
Business Name
Property Owner Information:
First Name
Last Name
Email
*
Phone Number
*
Property Address:
Street Number
*
Unit #
Street Name
*
Mailing Address Street #/POB (If different from property address)
City
State
Zip Code
HDWD Account Number:
By Checking this box I solemnly affirm under the penalties of perjury, and to the best of my knowledge, information and belief, that the contents of this application are true and complete.
*
Yes
Owner/Authorized Representative
*
Title
*
Date
*
Date
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